Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Prog Neuropsychopharmacol Biol Psychiatry. 2021 Jun 8;108:110181. doi: 10.1016/j.pnpbp.2020.110181. Epub 2020 Nov 21.
Several animal or case reports have demonstrated that methylphenidate (MPH) disrupts endogenous gonadal hormones and interferes with the pubescent development of children with attention-deficit/hyperactivity disorder (ADHD). Therefore, this prospective study examined the changes in gonadal hormones and pubescent development in children with ADHD undergoing 12-month MPH treatment. We recruited 146 patients with ADHD (mean age: 8.9 years, 76.7% males) and 70 healthy controls (mean age: 9.2 years, 65.7% males). Blood samples were obtained to measure the serum levels of sex hormone-binding globulin (SHBG), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, testosterone, free testosterone, and prolactin in each child. The sex maturation of ADHD patients was evaluated using the Tanner Stage. Patients with ADHD (107 received MPH treatment and 39 were under natural observation) were followed up for 12 months, and we re-examined hormone levels and Tanner Stage at the endpoint. During a 12-month follow-up for all ADHD patients, the serum levels of SHBG and progesterone significantly decreased, while LH, FSH, and free-testosterone levels significantly increased. However, the duration, drug formulations, and doses of the MPH treatment did not significantly influence gonadal hormone trends or changes of Tanner Stage. This study provides evidence about gonadal hormone trends and pubescent development in children with ADHD who receive long-term MPH treatment in natural settings. We suggest that MPH treatment at usual doses does not significantly alter gonadal function trends in ADHD patients over the course of one year.
一些动物或病例报告表明，哌醋甲酯（MPH）会破坏内源性性腺激素，并干扰患有注意缺陷多动障碍（ADHD）的儿童的青春期发育。因此，本前瞻性研究检查了接受 12 个月 MPH 治疗的 ADHD 儿童的性腺激素变化和青春期发育情况。我们招募了 146 名 ADHD 患者（平均年龄：8.9 岁，76.7%为男性）和 70 名健康对照者（平均年龄：9.2 岁，65.7%为男性）。采集血样测量血清中性激素结合球蛋白（SHBG）、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇、孕酮、睾酮、游离睾酮和催乳素的水平。使用 Tanner 分期评估 ADHD 患者的性成熟度。107 名 ADHD 患者（39 名接受 MPH 治疗，68 名接受自然观察）接受了为期 12 个月的随访，在终点时再次检查激素水平和 Tanner 分期。在所有 ADHD 患者的 12 个月随访期间，SHBG 和孕酮的血清水平显著降低，而 LH、FSH 和游离睾酮水平显著升高。然而，MPH 治疗的持续时间、药物配方和剂量并未显著影响性腺激素趋势或 Tanner 分期的变化。这项研究为在自然环境中接受长期 MPH 治疗的 ADHD 儿童的性腺激素趋势和青春期发育提供了证据。我们认为，在一年的时间内，常用剂量的 MPH 治疗不会显著改变 ADHD 患者的性腺功能趋势。
